Higher deprivation linked to lower CQC ratings, analysis suggests

Practices in areas with high deprivation struggle to perform as well in CQC inspections as those in more affluent areas, a GPonline analysis suggests.

Deprivation is linked to lower CQC ratings for GP practices (Photo: iStock)
Deprivation is linked to lower CQC ratings for GP practices (Photo: iStock)

Practices rated ‘inadequate’ or ‘requires improvement’ by the CQC are likely to be located in areas with more deprivation than practices rated ‘good’ and ‘outstanding’, according to the GPonline analysis.

The findings are the latest to suggest that GP practice CQC ratings are influenced by factors outside GPs' control, after previous investigations by this website found top-scoring practices are staffed by 50% more GPs, receive a third more funding and have list sizes twice as large as their lower-scoring counterparts.

However, the CQC insisted that external factors such as deprivation ‘do not have to be barriers’ to top-quality care, adding it had seen many examples of practices excelling in the face of deprivation and social challenges.

More CQC coverage and advice
Map: CQC ratings for every GP practice in England
> How to prepare for a CQC inspection
> How will CQC inspections change in 2018?

The latest GPonline findings are based on the final rating data for all GP practices inspected and rated in the CQC’s first round of inspections, which it completed earlier this year.

These were compared to the latest deprivation scores for each practice area, known as IMD scores. IMD scores for each practice were published by Public Health England (PHE), and can be used to provide a relative picture of deprivation in an area compared to others.

They incorporate seven domains – income, employment, education, health, crime, barriers to housing and living environment – to provide an overall picture of deprivation experienced by individuals living in an area.

GPonline calculated an average IMD value for practices given each rating of outstanding, good, requires improvement and inadequate was calculated.


The average score for outstanding was the lowest (20.8), followed by good (23.1), then requires improvement (25.2) and finally inadequate (26.8), suggesting that practices with higher CQC ratings tend to be in areas with comparatively less deprivation.

It comes after previous GPonline analyses have shown that a number of other external factors appear to affect what scores a GP practice will receive.

Results have suggested that top-scoring practices are staffed by 50% more GPs, receive a third more in funding and have list sizes twice as large as those at the bottom.

Other factors linked to where a practice is situated may influence practices’ CQC performance, with outstanding scores being up to five times more likely in those outside of London.

Why GP funding should be linked to deprivation

GPC chair Dr Richard Vautrey said the CQC’s one-size-fits-all rating system was too simplistic to provide an accurate picture of the care practices provide.

‘Lots of practices in the most deprived communities have often had the least investment over the years and are working in very difficult premises – often which haven’t been updated sufficiently to meet the needs for local populations,’ he told GPonline.

Practices serving these communities need more investment and support to help them work in these challenging environments, he added. ‘What we've said right from the beginning is that the simplistic rating scale used by the CQC is not fit for purpose. It doesn’t fit the reality facing practices. We have consistently raised concerns about this.’

CQC deputy chief inspector for general practice Ruth Rankine said: ‘Every practice exists in a unique environment, and the impact of where they are and who they will play a part in how they operate, but they do not have to be barriers to good and outstanding care.

‘When CQC was carrying out research for The State of Care in General Practice 2014 to 2017, inspection colleagues spoke of outstanding practice being delivered in deprived areas in and in the face of social challenges.

‘They had seen practices with clear strategies to deal with these issues and committed practice teams that that were passionate about improving care for people.

‘Practices can face different challenges and circumstances when delivering care whether they are an inner-city practice or a rural one, what matters is the way in which they identify and respond to local needs.’

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